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New Report Charts Slow Progress for Telehealth Reimbursement

The Center for Connected Health Policy issues an update of its March telehealth analysis, and notes that Hawaii will soon mandate malpractice insurance.

- Telehealth is slowly becoming an accepted means of delivering healthcare, according to the latest state-by-state analysis of the Center for Connected Health Policy.

An update of the CCHP’s fourth annual report, issued in March, finds that three states have added store-and-forward telehealth to their Medicaid programs and three have added some form of remote patient monitoring since that time.

Of special note, Hawaii has mandated, as of 2017, that liability insurers provide malpractice insurance for providers using telehealth at the same rate for in-person services.

“This may inspire other states to introduce similar legislation in the future,” the report stated.

The August edition of CCHP’s “State Telehealth laws and Medicaid Program Policies,” a 244-page update of the organization’s March report, notes that states are moving slowly, and in a piecemeal fashion, toward telehealth adoption and reimbursement. In all, it said, 44 states have introduced more than 150 telehealth-related pieces of legislation this year.

The CCHP, one of 14 federal telehealth resource centers scattered across the country, notes that while some states are moving forward, others are enacting laws “to restrict or place limitations on telehealth delivered services.”

According to the CCHP, 48 states and the District of Columbia now reimburse video visits in Medicaid fee-for-service programs, with Utah joining that list since March (it had been inadvertently left off the previous list) and Massachusetts and Rhode Island on the opposite side of the ledger. And while Iowa’s Medicaid program does reimburse for telehealth, researchers could not find a definition for telehealth in the lawbooks, “which leaves the policy vague and up for interpretation.”

With the addition of three states since March, the report notes that 12 states will reimburse for store-and-forward telehealth in their Medicaid programs by the end of this year, though some limit the use to certain specialties (California reimburses only for teledermatology, teledentisty and teleophthalmology, while Connecticut restricts it to an eConsult platform that works muck like a secure e-mail connection).

The platform is new and often the center of debate, the report noted.

“In many states, the definition of telemedicine and/or telehealth stipulates that the delivery of services must occur in ‘real time,’ automatically excluding store-and-forward as a part of telemedicine and/or telehealth altogether in those states,” it said.

And with three states – Hawaii, Kentucky and Missouri – legislation reimbursement for some form of remote patient monitoring in the near future, 19 states now allow reimbursement for RPM services, though on a limited basis.

“The most common … restrictions include only offering reimbursement to home health agencies, restricting the clinical condition for which symptoms can be monitored, and limiting the type of monitoring device and information that can be collected,” the report stated.

The report also noted that while states are moving toward expanding telehealth to all areas, not just rural or underserved regions, nine states still have restrictions, with Hawaii eliminating that barrier when its new law hits the books on January 1, 2017.

More common, the report, said, is a restriction on the so-called originating site: 25 states restrict where telehealth can be delivered – often eliminating the home as an originating site. On a positive note, since July 2015, the report noted, 10 states have modified language to add more locations to the list of originating sites.

According to the report, nine states require special licenses or certificates to practice telehealth in the state. Tennessee has eliminated its special license since March, while Montana and Nevada canned their special licenses within the past year. The report also notes that 17 states have so far signed on to the Federation of State Medical Board’s interstate Medical Licensure Compact, which is designed to streamline the licensure process for physicians applying for licenses in multiple states, ostensibly to practice telehealth.

Finally, the report notes that 35 states have passed laws governing reimbursements by private payers, with Washington’s law going into effect in 201t and Rhode Island’s in 2018.

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